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Biomedical subjects

L Bargues

Publications and source records attributed to L Bargues.

7 recordsLinked to original sources
PubMed2006

[Heparin-induced thrombocytopenia: report of four cases in severely burned patients].

Heparin-induced thrombocytopenia (HIT) is a dangerous complication of heparin therapy caused by an antibody against heparin/Platelet Factor 4 (PF4) complex. HIT complicates about 2% of treatment with unfractionated heparin (UFH). The aim of the study was to determine the incidence of HIT in a burn center and to report four cases in severely burned patients. HIT was documented in 2.8% of burns treated with UFH administered for antithrombotic prophylaxis and in none of burns receiving low molecular weight heparin (LMWH). All HIT cases occurred after extensive deep burns (mean total body surface area or TBSA was 60+/-21%) and three cases had above 75% of burn. We suggest that systemic platelet activation after thermal injury and local production of PF4 in the burn wound could participate to development of HIT. The risk is a late diagnosis since thrombosis clinical detection under burned skin is difficult. HIT appears during the first week of UHF treatment at the same time as a unstable period of fluctuating platelets.

Adult↗
PubMed2005

[Venous thromboprophylaxis in burn patient].

Few studies deal with thromboembolic complications in burn patients. The review of the literature and current practice in burn centres point out low, average and high-risk patients, according to the characteristics of the burns wounds. In case of average risk, low molecular weight heparin prophylaxis is suggested. In high risk patients, low molecular weight heparin therapy or continuous intravenous heparin are recommended. This prevention should be continued until the recovery of a normal mobility and complete resolution of inflammation.

Burns↗
PubMed2005

[Respiratory dysfunction in burned patients].

INTRODUCTION: Smoke inhalation and respiratory complications are still the major causes of mortality in severely burned patients. STATE OF THE ART: The diagnosis is suspected clinically on the basis of history and physical examination and can be confirmed bronchoscopically. Respiratory failure in burned patients occurs through a number of associated mechanisms. Pneumonitis and adult respiratory distress syndrome (ARDS) are common early complications. New pulmonary treatments and advances in ventilation have reduced the incidence of both barotrauma and infectious complications. Tracheal stenosis can occur as a late complication of prolonged mechanical ventilation. PERSPECTIVES: Clinical and experimental studies have shown that damage to the mucosal barrier and the release of inflammatory mediators are the most important pathophysiological events following smoke inhalation. Manipulation of the inflammatory response following inhalation may be a treatment option in the distant future. CONCLUSION: Inhalation injury occurring in burned patients can produce severe respiratory and systemic complications.

Animals↗
PubMed2002

[Inflammatory reaction and infection in severe burns].

Major burn injury is a lesion where the inflammatory reaction is exported to the whole body. After a short time of hemodynamic changes, this inflammation is kept by necrotic tissues, persistence of an opened wound, and by the pulmonary and gut reactions. When infection starts, it becomes difficult to distinguish its symptoms among the inflammatory signals. The main point of the care of burn patient consists in trying to control this reaction and the immuno-depression it leads to: early excision and grafts, early enteral nutrition, perfect nursing care. There is no specific medical treatment of this state. The antibiotic use must be well weighed up. Infection is often the trigger of the multiple organ dysfunction which is the way the burn patient dies but is not mandatory.

Burns↗
PubMed2000

Efficacy of continuous insufflation of oxygen combined with active cardiac compression-decompression during out-of-hospital cardiorespiratory arrest.

BACKGROUND: During experimental cardiac arrest, continuous insufflation of air or oxygen (CIO) through microcannulas inserted into the inner wall of a modified intubation tube and generating a permanent positive intrathoracic pressure, combined with external cardiac massage, has previously been shown to be as effective as intermittent positive pressure ventilation (IPPV). METHODS: After basic cardiorespiratory resuscitation, the adult patients who experienced nontraumatic, out-of-hospital cardiac arrest with asystole, were randomized to two groups: an IPPV group tracheally intubated with a standard tube and ventilated with standard IPPV and a CIO group for whom a modified tube was inserted, and in which CIO at a flow rate of 15 l/min replaced IPPV (the tube was left open to atmosphere). Both groups underwent active cardiac compression-decompression with a device. Resuscitation was continued for a maximum of 30 min. Blood gas analysis was performed as soon as stable spontaneous cardiac activity was restored, and a second blood gas analysis was performed at admission to the hospital. RESULTS: The two groups of patients (47 in the IPPV and 48 in the CIO group) were comparable. The percentages of patients who underwent successful resuscitation (stable cardiac activity; 21.3 in the IPPV group and 27.1% in the CIO group) and the time necessary for successful resuscitation (11.8 +/- 1.8 and 12.8 +/- 1.9 min) were also comparable. The blood gas analysis performed after resuscitation (8 patients in the IPPV and 10 in the CIO group) did not show significant differences. The arterial blood gases performed after admission to the hospital and ventilation using a transport ventilator (seven patients in the IPPV group and six in the CIO group) showed that the partial pressure of arterial carbon dioxide (PaCO2) was significantly lower in the CIO group (35.7 +/- 2.1 compared with 72.7 +/- 7.4 mmHg), whereas the pH and the partial pressure of arterial oxygen (PaO2) were significantly higher (all P < 0.05). CONCLUSIONS: Continuous insufflation of air or oxygen alone through a multichannel open tube was as effective as IPPV during out-of-hospital cardiac arrest. A significantly greater elimination of carbon dioxide and a better level of oxygenation in the group previously treated with CIO probably reflected better lung mechanics.

Adolescent↗